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  • Self-Reported Quality of Life Among Adolescents With Cerebral Palsy Similar to Peers Without Disability

    In what authors describe as "some of the most reliable evidence on how adolescents with cerebral palsy feel about life," a new study from Europe reports that in general, self-reported quality of life (QoL) among this population isn't that much different from their peers without disability, but could be even better with greater attention paid to pain early on.

    Researchers gathered responses to a survey (KIDSCREEN) issued to the same group of 355 individuals with cerebral palsy at 2 different points in their lives—as children aged 8 to 12 (average respondent age 10.4) and then later as adolescents aged 13 to 17 (average respondent age 15.1). The study compared the responses against results from adolescents without a disability and longitudinally within the respondents with cerebral palsy. An article describing the results was e-published ahead of print in the October 7 issue of The Lancet.

    "Our results are encouraging," authors write, stating that among the 10 QoL domains studied (physical wellbeing, psychological wellbeing, moods and emotions, self-perception, autonomy, relationships with peers, social support and peers, school life, finances, and social acceptance), adolescents with cerebral palsy were on a par with their peers without disabilities on 9 domains, with only "social support and peers" scoring lower for the group with cerebral palsy.

    "Individual and societal attitudes should be affected by the similarity [of scores] in children with cerebral palsy and the general population," authors write. "Only the quality of peer relationships is on average lower … and therefore such adolescents need particular help to maintain and develop peer relationships."

    When authors looked at the respondents with cerebral palsy from a longitudinal perspective, they found some correlation between psychological difficulties and parenting stress in childhood to lower QoL reporting in adolescence, and an even stronger connection between pain and the lower scores. "In the models combining the postulated predictors of [quality of life], pain, especially in adolescence, remained a significant predictor of QoL in all domains apart from autonomy, social support and peers, and financial resources," they write.

    "Although the rights of people with disabilities to participate in society are recognized and being implemented in many countries, adolescents with disabilities might still be regarded as having unhappy, unfulfilled lives," authors write. "Findings from qualitative studies, which challenge such a view, are now supported by our large epidemiological study. For children with below average QoL, early interventions to ameliorate high levels of psychological problems, parenting stress, and especially child pain, will probably have long-term benefits across many domains of the young person's life."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    Hospital Rates, Lengths of Stay Drop; Costs Continue 'Steady' 1.8% Rise

    "Greater use of chronic disease management programs and emphasis on outpatient treatment" may be part of the explanation for an overall decrease in inpatient hospital stays from 2003 to 2012, according to a recent report that analyzed community hospital use over a 10-year period (pdf).

    According to the study, hospitalization rates dropped by an average of .3% per year from 2003 to 2008, and an average of 1.8% per year from 2008 to 2012.

    The report, issued by the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, looked at rates, length, costs, and demographic variables related to hospitalization, and found that in addition to dropping rates, length of hospitalization also decreased by an average of .2% per year between 2003 and 2012.

    Other findings in the report:

    • Mean inflation-adjusted hospital costs grew at a "relatively steady" rate of 1.8% during the 10-year study period. Aggregate rates grew at an average 2.4% per year between 2003 and 2008, then slowed to a .7% growth rate after that.
    • The rate of hospitalization decreased from 128 stays per 1,000 population in 2003 to 116 stays per 1,000 population in 2012. The decrease was noted across all age groups but occurred at the highest rate for individuals 65 and over, a group that saw an average drop of 4% annually from 2008 to 2012.
    • The percentage of stays paid by Medicare increased from 37.1% in 2003 to 39.1% in 2012, while the percentage of stays paid by private insurers dropped, from 36.6% in 2003 to 30.6% in 2012.

    In looking at statistics related only to 2012 stays, the HCUP study reported 36.5 million stays during the year, with an average length of stay of 4.5 days, and cost of $10,000. As in previous years, most stays (56%) were medical, with 21.8% being surgical and 22.2% maternal/neonatal. Females had higher hospitalization rates than males during the year, but males averaged longer stays and higher costs.

    Nursing Homes, Home Health Agencies to Face Expanded Reporting, Quality Requirements

    Greater oversight of the data submitted to Medicare's nursing home rating service and a proposed rule that would apply more scrutiny to home health care agencies are among the changes announced this week by the White House and the Centers for Medicare and Medicaid Services (CMS). The announcements accompanied President Barack Obama's signing of the Improving Medicare Post Acute Care Transformation Act (IMPACT) earlier this week.

    On October 6, the White House announced that additional reporting and inspection requirements would be added to Nursing Home Compare, the five-star quality rating system for the nearly 16,000 nursing homes that participate in Medicare and Medicaid. Most of the changes are focused on greater CMS oversight of data related to staffing levels and quality measures, many of which are currently self-reported.

    The new system set to begin in 2015 will include a quarterly electronic reporting system on staffing that can be checked against payrolls for verification to monitor staff turnover and retention, types of staffing, and levels of staffing among those types. Overall ratings will be more closely tied to data verified by sources outside the nursing home itself.

    In addition, the ratings systems will expand the range of quality measurers used in Nursing Home Compare, beginning in 2015 with data on the extent to which antipsychotic medications are used in a facility, and expand to other areas including rehospitalization and return-to-home rates.

    At the same time the White House announced its actions on nursing homes, CMS released a proposed rule on home health agencies (pdf). That rule would require agencies who participate in Medicare and Medicaid to provide clear explanations of patient rights, expand patient assessments, and establish systems for improved coordination of care among providers, among other changes. The rule would also expand patient care coordination by requiring a licensed clinician responsible for all patient care services. CMS expects to have a final rule in place in 2015.

    APTA will continue to monitor these changes and proposals, and will provide comments on the home health rules proposals as well as keep members informed on progress and implementation.